Active NPI
State of Colorado
Doing business as Colorado Veterans Community Living Center Homelake
- Skilled Nursing Facility
- Monte Vista, CO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 2023
- Legal business name
- STATE OF COLORADO
- Doing business as
- Colorado Veterans Community Living Center Homelake
- Practice address
- 3749 Sherman Ave
Monte Vista, CO 81144-9403 - Phone
- (719) 852-5118
- Fax
- (719) 852-3881
- NPI assigned
- Dec 5, 2006
- Last updated
- Jul 12, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Mindy Montague
- Title
- Administrator
- Phone
- (719) 852-5118
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2023 | CO | Primary |
Addresses
Primary practice location
3749 Sherman Ave
Monte Vista, CO 81144-9403
Mailing address
PO Box 97
Homelake, CO 81135-0097
Phone (719) 852-5118
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05653274 | Medicaid | CO |
Other names 1
- Colorado Veterans Community Living Center Homelake
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070201000408 | CO | Part A Provider - Skilled Nursing Facility | 5991613812 | Practice locations: Monte Vista, CO |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1114085875. Details of each certification follow.
Skilled nursing facility certification: CCN 065391
- Legal name
- STATE OF COLORADO
- Doing business as
- COLORADO VETERANS COMMUNITY LIVING CENTER - HOMELAKE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 1, 2007
- Last certification
- Oct 17, 2024
- Beds
- 60
- Ownership / control type
- State
- Multi-facility organization
- State of Colorado
- Organization structure
- Government
- Enrollment address
- 3749 Sherman Ave
Monte Vista, CO 81144-9403 - Nursing home name
- COLORADO VETERANS COMMUNITY LIVING CTR AT HOMELAKE
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Colorado Veterans Community Living Center at Fitzsimons Phar
- Community/Retail Pharmacy
- Aurora, CO
- NPI 1053579177
5991613812
-
dba Colorado State Veterans Nursing Home - Rifle
- Skilled Nursing Facility
- Rifle, CO
- NPI 1093702722
5991613812
-
dba Colorado Mental Health Institute Pueblo
- Psychiatric Hospital
- Pueblo, CO
- NPI 1144352550
5991613812
-
dba Colorado State Veterans Home at Fitzsimons
- Skilled Nursing Facility
- Aurora, CO
- NPI 1508931536
5991613812
-
dba Colorado Mental Health Institute Fort Logan
- Psychiatric Hospital
- Denver, CO
- NPI 1548393937
5991613812
-
dba Bruce McCandless Colorado State Veterans Nursing Home
- Skilled Nursing Facility
- Florence, CO
- NPI 1669470910
5991613812
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Colorado Veterans Community Living Ctr at Homelake
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Government - State
- Certified
- Dec 1, 2007
- Medicare certification status
- Active
- Certified beds
- 60
National Provider Directory
National Provider Directory- Tax ID family
- Fort Lyon Correctional Facility
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Prison Health Clinic/Center
- Canon City, CO
- NPI 1104716240
-
- Prison Health Clinic/Center
- Ordway, CO
- NPI 1154219806
-
- Prison Health Clinic/Center
- Pueblo, CO
- NPI 1235027889
-
dba Colorado Charter School Institute
- Local Education Agency (LEA)
- Denver, CO
- NPI 1225113012
-
- Psychiatric Hospital Unit
- Denver, CO
- NPI 1053444315
-
- Psychiatric Hospital Unit
- Denver, CO
- NPI 1063545325
-
- Skilled Nursing Facility
- Aurora, CO
- NPI 1073500450
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Denver, CO
- NPI 1144132705
-
- Developmentally Disabled Services Day Training Agency
- Grand Junction, CO
- NPI 1104959477
-
- Developmentally Disabled Services Day Training Agency
- Grand Junction, CO
- NPI 1205522992
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Pueblo, CO
- NPI 1043759541
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Pueblo, CO
- NPI 1043759558
Ownership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Christa Davis | W-2 Managing Employee | Feb 2, 2007 | |
| Erin Marjorie Aldrich | W-2 Managing Employee | Oct 8, 2022 | |
| Mindy Kerr Montague | W-2 Managing Employee | Feb 2, 2007 | |
| State of Colorado | 5% Or Greater Direct Ownership Interest | Jan 12, 2007 |
Owners & managing parties with NPI records 6
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
dba Colorado Veterans Community Living Center at Fitzsimons Phar
- Community/Retail Pharmacy
- Aurora, CO
- NPI 1053579177
5% Or Greater Direct Ownership Interest
-
dba Colorado State Veterans Nursing Home - Rifle
- Skilled Nursing Facility
- Rifle, CO
- NPI 1093702722
5% Or Greater Direct Ownership Interest
-
dba Colorado Mental Health Institute Pueblo
- Psychiatric Hospital
- Pueblo, CO
- NPI 1144352550
5% Or Greater Direct Ownership Interest
-
dba Colorado State Veterans Home at Fitzsimons
- Skilled Nursing Facility
- Aurora, CO
- NPI 1508931536
5% Or Greater Direct Ownership Interest
-
dba Colorado Mental Health Institute Fort Logan
- Psychiatric Hospital
- Denver, CO
- NPI 1548393937
5% Or Greater Direct Ownership Interest
-
dba Bruce McCandless Colorado State Veterans Nursing Home
- Skilled Nursing Facility
- Florence, CO
- NPI 1669470910
5% Or Greater Direct Ownership Interest
All facility ownership & control disclosures 4
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Colorado Mental Health Institute Pueblo | Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Apr 11, 2013 Apr 11, 2013 |
| Colorado Mental Health Institute at Fort Logan | Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1966 |
| Colorado Veterans Community Living Center | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jan 1, 2015 Jan 1, 2015 |
| Colorado Veterans Community Living Center at Florence (Bruce McCandles | Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 1975 |
Owned or controlled facilities with NPI records 5
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
dba Colorado State Veterans Nursing Home - Rifle
- Skilled Nursing Facility
- Rifle, CO
- NPI 1093702722
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Colorado Mental Health Institute Pueblo
- Psychiatric Hospital
- Pueblo, CO
- NPI 1144352550
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
- Psychiatric Hospital
- Pueblo, CO
- NPI 1326170739
5% Or Greater Direct Ownership Interest, Operational/Managerial Control
-
dba Colorado Mental Health Institute Fort Logan
- Psychiatric Hospital
- Denver, CO
- NPI 1548393937
5% Or Greater Direct Ownership Interest
-
dba Bruce McCandless Colorado State Veterans Nursing Home
- Skilled Nursing Facility
- Florence, CO
- NPI 1669470910
5% Or Greater Direct Ownership Interest
Facilities with the same owner 4
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Colorado State Veterans Nursing Home - Rifle
- Skilled Nursing Facility
- Rifle, CO
- NPI 1093702722
State of Colorado
-
dba Colorado Mental Health Institute Pueblo
- Psychiatric Hospital
- Pueblo, CO
- NPI 1144352550
State of Colorado
-
dba Colorado Mental Health Institute Fort Logan
- Psychiatric Hospital
- Denver, CO
- NPI 1548393937
State of Colorado
-
dba Bruce McCandless Colorado State Veterans Nursing Home
- Skilled Nursing Facility
- Florence, CO
- NPI 1669470910
State of Colorado
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1626048000000",
"number": "1114085875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 97",
"city": "HOMELAKE",
"state": "CO",
"postal_code": "811350097",
"telephone_number": "719-852-5118",
"fax_number": "719-852-3881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3749 SHERMAN AVE",
"city": "MONTE VISTA",
"state": "CO",
"postal_code": "811449403",
"telephone_number": "719-852-5118",
"fax_number": "719-852-3881"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STATE OF COLORADO",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-05",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A",
"authorized_official_last_name": "MONTAGUE",
"authorized_official_first_name": "MINDY",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "719-852-5118",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "CO",
"license": "2023",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05653274",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Colorado Veterans Community Living Center Homelake",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Monte Vista, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.